Surgery EOR: Cardiovascular Test Exam
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What is acute arterial occlusion?
Sudden interruption of arterial blood flow due to thrombosis or
embolism - surgical emergency requiring intervention within 6 hours
What is the classic "6 Ps" of acute arterial occlusion?
Pain, Pallor, Pulselessness, Paresthesias, Paralysis, Poikilothermia
(cold extremity)
What is the most common cause of acute arterial occlusion?
Embolism (80-90%) - commonly from atrial fibrillation, MI with mural
thrombus, or valvular heart disease
What is the most common site for acute arterial occlusion?
Femoral artery bifurcation (common femoral) followed by iliac,
popliteal, and brachial arteries
How is acute arterial occlusion diagnosed?
Clinical diagnosis with 6 Ps, absent distal pulses; confirm with CT
angiography or conventional angiography
What is the immediate management of suspected acute arterial
occlusion?
IV heparin bolus (80 units/kg) followed by infusion, pain control,
protect limb, urgent vascular surgery consultation
,What are the treatment options for acute arterial occlusion?
Surgical embolectomy (Fogarty catheter), thrombolysis (catheter-
directed tPA), bypass grafting, or amputation if non-viable
What factors determine limb viability in acute arterial occlusion?
Rutherford classification: Class I (viable), Class IIa (threatened,
salvageable), Class IIb (threatened, immediate), Class III (irreversible)
What is reperfusion injury after revascularization?
Release of toxic metabolites causing hyperkalemia, acidosis,
myoglobinuria, compartment syndrome - can lead to renal failure
What indicates irreversible limb ischemia?
Fixed mottling, muscle rigor, absent Doppler signals, paralysis >6
hours - amputation required to prevent systemic complications
What is an aortic aneurysm?
Permanent focal dilation of aorta >50% of normal diameter (AAA:
>3cm, thoracic: >4cm in ascending, >3.5cm in descending)
What are the risk factors for abdominal aortic aneurysm (AAA)?
Smoking (strongest modifiable), male sex, age >65, hypertension,
family history, atherosclerosis, connective tissue disorders
What is the classic triad of ruptured AAA?
Abdominal/back pain, hypotension, pulsatile abdominal mass -
present in only 50% of cases
Who should be screened for AAA and how?
Men age 65-75 with smoking history - one-time ultrasound screening
(USPSTF Grade B recommendation)
At what size should AAA be repaired electively?
≥5.5cm in men, ≥5.0cm in women, or growth >0.5cm in 6 months or
>1cm per year
, What imaging is used for AAA diagnosis and surveillance?
Ultrasound for screening/surveillance; CT angiography for
preoperative planning and acute evaluation
What are the surgical options for AAA repair?
Open surgical repair (OSR) or endovascular aneurysm repair (EVAR) -
EVAR preferred when anatomy suitable
What is the mortality rate of ruptured AAA?
Overall 80-90% mortality - 50% die before reaching hospital, 50%
operative mortality for those reaching surgery
What medications reduce AAA expansion rate?
Beta-blockers, statins, ACE inhibitors - smoking cessation most
important intervention
What are complications of EVAR?
Endoleak (most common), graft migration, limb thrombosis, infection
- requires lifelong surveillance imaging
What is aortic dissection?
Tear in aortic intima allowing blood to enter media creating false
lumen - can propagate proximally or distally
What is the Stanford classification of aortic dissection?
Type A: involves ascending aorta (requires emergency surgery); Type
B: descending aorta only (medical management unless complicated)
What are the classic presenting symptoms of aortic dissection?
Sudden severe "tearing" or "ripping" chest/back pain, often described
as worst pain ever, may migrate as dissection propagates
What are the risk factors for aortic dissection?
Hypertension (most important), Marfan syndrome, Ehlers-Danlos
syndrome, bicuspid aortic valve, cocaine use, trauma
(Most Recent Version) Focused Questions
and Answers / Get 100% Answers and
Already Graded A+
What is acute arterial occlusion?
Sudden interruption of arterial blood flow due to thrombosis or
embolism - surgical emergency requiring intervention within 6 hours
What is the classic "6 Ps" of acute arterial occlusion?
Pain, Pallor, Pulselessness, Paresthesias, Paralysis, Poikilothermia
(cold extremity)
What is the most common cause of acute arterial occlusion?
Embolism (80-90%) - commonly from atrial fibrillation, MI with mural
thrombus, or valvular heart disease
What is the most common site for acute arterial occlusion?
Femoral artery bifurcation (common femoral) followed by iliac,
popliteal, and brachial arteries
How is acute arterial occlusion diagnosed?
Clinical diagnosis with 6 Ps, absent distal pulses; confirm with CT
angiography or conventional angiography
What is the immediate management of suspected acute arterial
occlusion?
IV heparin bolus (80 units/kg) followed by infusion, pain control,
protect limb, urgent vascular surgery consultation
,What are the treatment options for acute arterial occlusion?
Surgical embolectomy (Fogarty catheter), thrombolysis (catheter-
directed tPA), bypass grafting, or amputation if non-viable
What factors determine limb viability in acute arterial occlusion?
Rutherford classification: Class I (viable), Class IIa (threatened,
salvageable), Class IIb (threatened, immediate), Class III (irreversible)
What is reperfusion injury after revascularization?
Release of toxic metabolites causing hyperkalemia, acidosis,
myoglobinuria, compartment syndrome - can lead to renal failure
What indicates irreversible limb ischemia?
Fixed mottling, muscle rigor, absent Doppler signals, paralysis >6
hours - amputation required to prevent systemic complications
What is an aortic aneurysm?
Permanent focal dilation of aorta >50% of normal diameter (AAA:
>3cm, thoracic: >4cm in ascending, >3.5cm in descending)
What are the risk factors for abdominal aortic aneurysm (AAA)?
Smoking (strongest modifiable), male sex, age >65, hypertension,
family history, atherosclerosis, connective tissue disorders
What is the classic triad of ruptured AAA?
Abdominal/back pain, hypotension, pulsatile abdominal mass -
present in only 50% of cases
Who should be screened for AAA and how?
Men age 65-75 with smoking history - one-time ultrasound screening
(USPSTF Grade B recommendation)
At what size should AAA be repaired electively?
≥5.5cm in men, ≥5.0cm in women, or growth >0.5cm in 6 months or
>1cm per year
, What imaging is used for AAA diagnosis and surveillance?
Ultrasound for screening/surveillance; CT angiography for
preoperative planning and acute evaluation
What are the surgical options for AAA repair?
Open surgical repair (OSR) or endovascular aneurysm repair (EVAR) -
EVAR preferred when anatomy suitable
What is the mortality rate of ruptured AAA?
Overall 80-90% mortality - 50% die before reaching hospital, 50%
operative mortality for those reaching surgery
What medications reduce AAA expansion rate?
Beta-blockers, statins, ACE inhibitors - smoking cessation most
important intervention
What are complications of EVAR?
Endoleak (most common), graft migration, limb thrombosis, infection
- requires lifelong surveillance imaging
What is aortic dissection?
Tear in aortic intima allowing blood to enter media creating false
lumen - can propagate proximally or distally
What is the Stanford classification of aortic dissection?
Type A: involves ascending aorta (requires emergency surgery); Type
B: descending aorta only (medical management unless complicated)
What are the classic presenting symptoms of aortic dissection?
Sudden severe "tearing" or "ripping" chest/back pain, often described
as worst pain ever, may migrate as dissection propagates
What are the risk factors for aortic dissection?
Hypertension (most important), Marfan syndrome, Ehlers-Danlos
syndrome, bicuspid aortic valve, cocaine use, trauma
